Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Monday, April 30, 2007

War Story

"Doc, you gotta help me. I can't take it any more."

In the midst of the assorted humdrum and the occasional catastrophe, that was the complaint I heard the most when I served in Vietnam. And mind you, compared to the grunts, I had it way good. I, and the people for whom I was a doctor, lived on a base, not in the jungle. It was up north a ways, not far from the DMZ, and 160 mm rockets thumped (when far away) and crashed (when close) their way across the base pretty much every night. "Oh, Rocket City," was what people said when I told them where I'd been assigned. Still, by some measures, you could call it cushy. And that's my point. War, even at its edges, ravages people. The threat of random rockets dropping through the roof of your barracks can lead to "I can't take it any more." Think of the guys on patrol in Iraq and what their job does to them.

A twenty-two year old Marine from my community -- he went to school in the district for which my wife has served on the school board for ten years -- is facing court martial for his actions when on patrol (his third tour) in Iraq. I read another article about him today in the local paper, and it pierced my heart. I can't speak to the details; nor would I excuse it if crimes are committed by troops. But I can understand. It's something you don't hear much, in conversations about this war or any other. Taking young people -- teenagers and barely beyond -- and teaching them to be killers, then putting them in the situation where that's exactly what they must do, where they see death all around them in the most horrible of ways, where they live with knowing it could end in a second; taking humans and telling them to stop being human for a while while expecting that they can turn it all back on at will and at once; plainly, that's not a realistic expectation. It's a grand delusion. How outraged are we who sent them there entitled to be when, under circumstances in which most of us have never been (obvious comment about our leadership omitted here), they react? (I was going to say "over-react." What, exactly, is over-reaction to being spattered with the brains of a friend? Slipping on your own blood or someone else's? I see guts all the time. Those kids hadn't until they tripped on them.)

When I arrived in Danang, I was horrified at the attitude of the GIs towards the South Vietnamese troops on our base. "Zips," they called them, and it was in the most derisive inflection. (I think the origin had to do with the garish flight suits, full of zippers all over the place.) These are the people we're here to help, I thought. In time, I'm sorry to say, I came to feel the same: base security under them was abysmal. Sapper attacks were frequent, barracks were regularly stripped of personal stuff -- all because the guards let bad guys sneak in. Worse, most of the rockets originated nightly from "friendly villages," meaning nearby locations into which the GIs couldn't go, by the rules of engagement, without permission from the locals. So in the morning we were told how many and from where, and in the evening the steel storks would deliver their babies.

It was a big base. Odds were, any given person would be OK. But not everyone was. I stuffed my shirt into a torrential wound one night in front of my barracks. The man lived long enough for the Huey to arrive, not much longer. As the only doc living on the flight line, which was very near our clinic, while the sirens of the night were still sobbing I had to don a flak vest and helmet and run down the often-muddy road to the tiny hospital, as helicopters diced the air overhead, hosing the jungle just over the fence. Tracers were only every sixtieth round; yet the bullets came at such a rate that it was like a searchlight. Each time I ran that road, hunched, I lagged behind myself, looking without entirely comprehending. What am I doing here? What's wrong with us humans? And who is that guy up there?

I used the math -- small rockets times big base -- to keep fear at subconscious level. I think most soldiers do. When my barracks got hit and I got hurt, I figured I'd had my time, and had lucked out. But I slept under my bed thereafter.

As a doctor, I've tried to help guys cope -- guys who, compared to the young man from my town, had a hell of a lot less with which they had to cope. In charge of Medevac for a while, I saw guys come through on their way home, handed Purple Hearts in exchange for their limbs. Legal tender. Overtly wounded or not, those guys won't be the same. You carry stuff around. Easy as I had it, I still hate the sound of helicopters.

My place in the war was far from the center, but I've been there and I've felt the effects and seen them in my patients, if only a little. I'm no pacifist. It'll be another million years of evolution before war is unnecessary, and I'd fight if I had to. But no matter what he did, I feel sorry as hell for that kid from my town. Whatever he did, something was done to him by us, in our name. Because our leaders deemed it necessary, his life is ruined. And I hate it -- I absolutely hate it -- when I hear hard-on holding TV pundits and chest-thumping politicos who haven't the slightest clue what war does to people getting all teary-eyed about "sacrifice" and square-jawed about bravery. Not to mention people who get shocked when a soldier living in that world goes off the deep end. It's what happens. When we send kids to war, sticking little magnets on our bumpers, putting down the remote long enough to give the finger to peaceniks; when we force our young to leave their humanity behind (while telling them not to and pretending it's possible), we ought to be damn sure -- we ought to be god damn sure there's absolutely no other choice. The only people for whom war is glorious are those who never were in one. It's tragedy of the most awful sort, and I wish more people would behave as if they knew it. Starting at the top.

"My fellow Americans," the President ought to say in declaring war. "We are now a nation at war. People will die. Innocent people will die. Lives will be destroyed, because war does that. We hope our soldiers will not be indiscriminate, but we know some will. For in asking them to go to war, we are telling them to leave civilization behind, because war is its opposite. Of the soldiers we are sending to war, many will die. Of those that return home, many will be maimed for life, body and soul. Because we have asked this thing of them, we must also commit to nurturing those that return. They do not go to war alone. We must support them with more than words, and that means we must all bear the burden of this awful decision; it is our duty to our soldiers, it is our obligation forever. We will name them and learn of them, as we did with those at Virginia Tech and Columbine. We will see their coffins, hear the words of their loved ones. And we must pay for this war in every way, from its beginning and beyond its end. That means I will impose a tax surcharge to pay for the immediate costs and those of rebuilding ourselves afterwards, for as long as it takes. And because we ask sacrifice of our fighting men and women, I ask it of everyone. In going to war we have concluded there is no other way, that our very survival is at stake. It is the most important and terrible thing we do as a nation. So I will impose a draft on each and every American. Those that can't fight will build the machines of war. Those that can't build will do our work in their offices, their homes. War is cataclysm, and everything else is secondary, and thus it will remain until we have prevailed. That is what war is. That is what sacrifice is. May God forgive us."

Dr. Schwab,I'm a US Marine who was wounded in Iraq. I also have PTSD. For three years now, I've been turned away by doctors who tell me there's nothing wrong with me, that I just have to deal with it. I can't tell you how much it means to me that someone in your position can actually understand what we go through. Thank you. Michael Sahling Lance Corporal United States Marine Corps

Yes, Dr. Schwab, the loss of limbs is terrible but when they lose their peace of mind also, that is heartbreaking. I, too, am the mother of a Marine. By the grace of God he lost no body parts though he did receive two Purple Hearts. What he left of himself over in Iraq is irreplacible. When he was buried under a three story building he left more than half of his lifetime's memories and healthy kidneys.

We ask so much of these boys and girls. A speech and plan such as you suggest is just and fair. In fact, it is very little to ask of a caring and competent head of state. Thank you for stating it so well. I wish my son could talk to you. Perhaps his mind would then begin to ease. Again, thank you for the words I couldn't find.

Dr Schwab,This is one of the most moving posts I've read. I know I will probably never fully understand what those who have experience war have dealt with. And honestly, I hope I never do. But I know that, at 19, I'm not even close to equipt to deal with these kinds of things. And yet, so many people my age have been, and still are expected to cope, and I have no idea how they do, because no matter how tough I think I am, I'm not sure I could step up and do what is expected of them. So my respect and admiration goes out to anyone who can.

Great post Dr. Schwab. My son is 101st Airborne and will be soon returning to Iraq for his third tour. We were talking shortly after his return from his first tour and he told me that the most awful thing was the loss of himself there. He said that when he had to kill others, a part of his soul died in the exchange. Not that I disagree, or am trying to challenge you, but I do wonder if we as a nation were so inclined to pursue the recommendation that you set forth, what would that support for our troops look like. I look at the magnets on the back of cars and think to myself that it means so little. I hear congress speak about witholding funding for the war, and I wonder if they don't know that what it boils down to is that a soldier won't have proper weapons, equipment or provisions. I wonder if they don't realize that it will mean that the soldiers won't get a raise or a promotion and the family that relies on the income will struggle. If you cut funding then there won't be money for proper medical and psychological care. My son left in 2003 saying "We'll be home in six weeks Ma." I am as exasperated that he is going back as anyone could be. But I can't support a lack of support for the troops. Thank you that you have made this statement of support for them.

IM HM2(FMF) Heidrich... ive been over twice, and im looking at an eventual third tour.. ive seen a lot of friends around me broken, both physically and mentally.. I dont have the same problems they do, but i wonder what this third time will be. I am extremely respectful and appreciative of the exampls Doctors like you have set for Corpsman like me. Thanks for still caring about us all these years later.... And to all the marine moms, I swear I wish we could save them all, I hope they can find the healing they need. God Bless.

But...I don't understand how this particular war works. We send the guys over there to fight an enemy they can't see, that blends into the countryside, tell them they can't do what they need to do and then wonder why things seem so disorganized.

So, young people - go to war and risk your life but....you can't go here, can't go there, can't shoot here, respect every single mosque even if they are shooting at you from the windows....these are the weirdest rules of engagement. I've ever seen.

Anyway, I'm getting off track. This was a wonderful post - I hope we do a better job with supporting our Iraq War veterans at home AFTER the war than we did with our Vietnam vets.

Sid, this blog should be required reading for all our elected officials in Washington, starting, as you said, "at the top." It should be done immediately after taking the oath of office. Every non-vet should read it, too. (I don't think any vets need to.) Thanks.

Sid: In your superb essay on Iraq you state "My fellow Americans, the president should say, in declaring war"....well, unfortunately, we did NOT declare war in VietNam (17 years), Bosnia, Somalia, Gulf I, Afghanistan or Iraq (now over 4 years).The Constitution clearly gives Congress the power to DECLARE War, but no, we do this Commander-in-Chief baloney and that has made all the difference. A declaration puts everybody on the line..stand up and vote, up or down. Go or don't go. Believe intelligence or reject it. But no Commander wars any more, please. A declaration enables us to censor, draft, appropriate, execute for treason and WIN rather than fight with hands tied behind our backs. As a former Army major, Surgeon in VietNam, I can, as can you, testify to the waste and suffering of a prolonged, dragged out stalemate as the home-front cheering section becomes hostile. Thanks for the essay, the great site and for Cutting Remarks, my very favorite doctor book of all time.

A simply beautiful post! And a great reminder that there's no shared sacrifice in this war. People who have never been closer to a war than a movie theater showing Saving Private Ryan call the shots, asking our soldiers to kill and die for a dubious cause. Thank you for your eloquence and your compassion.

i think one of the biggest disappointments i have in my generation is that we did not learn from viet-nam.and now the old men of our generation are the ones sending young men off to be maimed and killed in a war

Right. A draft is what is needed. That way everyone is in it and so everyone will be part of the solution too, which may be continuing or shutting it down. More then will ask what is really going on because the stakes are higher. But no politician will stick his neck out on that one except Charles Rangel of NY.Supporting the troops is asking if they are dying for a just cause for which there is no other solution. I wish there was a better way to help the returning soldiers. Can yougive some info or links on how to help?Thanks for a compelling post.

About Me

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.